The need for guidelines for the practice of hemodialysis in the kingdom of saudi arabia: a questionnaire survey.

Hemodialysis remains the most widely used form of renal replacement therapy world-wide. In view of the large number of patients who are on maintenance hemodialysis in Saudi Arabia, it was felt to have some sort of guidelines to standardize dialysis delivery in the Kingdom. We performed a survey on various aspects of dialysis delivery. A detailed questionnaire was sent to 120 hemodialysis centers in the Kingdom and response was obtained from 55 (45.8%). The questionnaire consisted of questions for which answer on the present situation and ideal recommendation were sought. With these data, it is hoped to have proper guidelines that can be laid down to assist the practicing nephrologists in the Kingdom in optimizing dialysis delivery.

Percutaneous renal biopsy and its findings in children and adolescents in saudi arabia: a single center experience.

A retrospective study of 108 consecutive renal biopsies in children and adolescents below 18 years of age performed at the King Fahd Hospital, Jeddah, during an eight-year period ending 1996, was made. All the biopsies were performed by a single consultant nephrologist and under ultrasound guidance. Tru-cut needles were employed in all cases and in the last two years, the bioptic gum was used. The age of the patients ranged between 3 months and 18 years with a mean of 10.6 years. There were 58 males and 50 females. All patients tolerated the biopsy well and there were no failures. The common side effects noted included gross hematuria in three (2.8%) and severe pain at the biopsy site in 11 (10.2%). None of the patients needed blood transfusions or prolonged hospitalization. Nephrotic syndrome was the commonest indication for performing the biopsy (83.3%) and among them, minimal change was the commonest lesion found (25%) followed by focal and segmental glomerulosclerosis (14.8%) and mesangial proliferative glomerulonephritis (15.7%). Our study further shows that renal biopsy is a safe procedure in children and the commonest indication is nephrotic syndrome.

Kaposi's sarcoma in renal transplant recipients.

One hundred and seventeen of 270 (43%) recipients of organs obtained from donors with malignancies had evidence of transmitted cancers. In 9 instances these were removed from renal allografts immediately prior to transplantation. Including these cases there were 45 recipients of organs in which a neoplasm involved the allograft, 6 others in whom adjacent structures were invaded, and another 66 patients who had distant metastases. Precautions to prevent cancer transmission include meticulous preoperative screening of donors, careful examination of all organs at the time of harvesting, biopsy of any suspicious lesions, and routine donor autopsy, if possible.

Use of Erythropoietin in the Correction of Anemia in Pre-dialysis Patients.

Anemia is a well recognized complication of chronic renal failure (CRF). Although the use of erythropoietin (EPO) in the treatment of anemia in patients on dialysis is well established, its use in pre-dialysis patients is less well recognized. The preferred route of administration of EPO in pre-dialysis patients is subcutaneous and it is indicated in any patient with CRF who is symptomatic of anemia. Studies have shown that EPO is effective in correcting anemia in these patients with a considerable improvement in quality-of-life scores. There have been no deleterious effects on blood pressure or rate of decline of renal function. However, these two indices should be monitored closely. Common causes of treatment failure include iron deficiency, blood loss and occult sepsis. The available evidence indicates that EPO therapy is safe and effective in the treatment of anemia in pre-dialysis patients.

Retroperitoneal hemorrhage following trauma during femoral vein cannulation for hemodialysis--a therapeutic dilemma.

A 16-year-old male with acute renal failure developed traumatic retroperitoneal hemorrhage following femoral vein cannulation for hemodialysis. Ultrasonographic imaging accurately delineated the extent of the hematoma, However, the site of the leak could not be identified at surgery and the patient could not be saved.